What are the patient''s acid-base and oxygenation statuses

Reference no: EM133250242

Case: Ms. Yen is a 23-year-old woman who was feeling fine until the morning of admission, when she began having severe chills, vomiting, diarrhea, headache, and a fever of 40*C. The symptoms persisted throughout the day and caused her to seek medical attention at the local ED. Ms. Yen had an intrauterine device (IUD) inserted at a local family planning clinic three days before admission. At the time of admission, she denied shortness of breath, wheezing, sputum production, cough, hemoptysis, orthopnea, chest pain, illicit drug use, or exposure to TB.

Physical Exam:
General: The patient is well-nourished, alert, and oriented; she appears anxious, but there is no evidence of respiratory distress.
Vital Signs: Temp of 40*C; RR of 24bpm; HR of 104/min; BP of 126/75
Chest: Normal configuration and expansion while breathing; normal resonance to percussion bilaterally.
Lungs: CTA bilaterally
Abdomen: Lower abdominal tenderness to palpation.
Extremities: No cyanosis, edema, or clubbing.
Laboratory Data: CBC - WBC of 15,500 (high). Ms. Yen has been started an IV antibiotic therapy. Results of a uterine swab show gram-negative diplococci, and a preliminary blood culture also shows gram-negative cocci.

Twelve hours later, she begins complaining of increased shortness of breath.

Assessment:
RR of 34bpm; HR of 120/min
She is using accessory muscles to breathe, and chest auscultation now reveals fine, inspiratory crackles bilaterally.
ABG: pH: 7.25; PaCO2: 21 mmHg; HCO3: 16 mEq/liter; PaO2: 62 mmHg; SaO2: 88%

The patient continues to experience severe respiratory distress and is given an entrainment device with a FiO2 of 60%. ABG on 60%.
pH: 7.26; PaCO2: 35 mmHg; HCO3: 16 mEq/liter PaO2: 49 mmHg
Assessment: RR of 38bpm, HR of 134/min

Question:

After twelve hours, what are the patient's acid-base and oxygenation statuses? What pathophysiology accounts for the adventitious lung sounds (fine, inspiratory crackles?)

Reference no: EM133250242

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